Measuring Race and Ethnicity: Why and How?

Measuring Race and Ethnicity: Why and How?

The Journal of the American Medical Association
Volume 292, Number 13 (2004)
pages 1612-1614
DOI: 10.1001/jama.292.13.1612

Margaret A. Winker, MD, Deputy Editor and Online Editor
Journal of the American Medical Association

Race and enthnicity are constantly evolving concepts, deceptively easy to measure and used ubiquitously in the biomedical literature, yet slippery to pinpoint as definitive individual characteristics. A current dictionary definition of race is “a family, tribe, people, or nation belonging to the same common stock, or a class or kind of people unified by shared interests, habits, or characteristics.” For 154 years, the US government has defined race for its census takers, and for many years census takers then defined it for US residents. The terms used reflect the nation’s changing demographics and increasing recognition of human diversity. The 1850 enumerators used a form that assumed a default race of white, with a checkmark indicating nonwhites as black or mulatto, with additional indications for free or slave. Indian was added as a category in 1860. Since 1960, individuals have been able to specify their own race and ethnicity, and by 2000 the census enumerated 126 racial and ethnic categories.

Medical definitions of race have lagged behind, although thankfully the former Medical Subject Headings (MeSH) terms such as Caucasoid, Mongoloid, Negroid, and Australoid rarely appear in biomedical literature. Given that the connotations and definitions of race and ethnicity are constantly evolving, the use of the terms and concepts of race and ethnicity in the biomedical literature deserves examination…

…The use of race as a proxy for unmeasured confounders, such as cultural, social, and environmental influences, is commonplace, but race is a poor proxy for these measures. The life experience and cultural milieu of US immigrants may be completely different from those who grew up in the United States, despite being assigned to similar racial or ethnic categories. Socioeconomic status, not race, is likely the greater determinant of health and health-related qualities. Therefore, race is not a substitute for carefully assessed social and cultural characteristics.

On the other hand, race can be an important indicator of health disparities and health care delivery. An American College of Physicians position paper attests to “…ample evidence illustrating that minorities do not always receive the same quality of health care, do not have the same access to health care, are less represented in the health professions, and have poorer overall health status than nonminorities.” While race is just a departure point when evaluating such disparities, the article by Bradley et al in this issue of JAMA illustrates how race can be used along with specifically defined characteristics to begin to explore some of the reasons behind health disparities. In this retrospective, observational study of inpatients from the US-based National Registry of Myocardial Infarction, who were hospitalized during 1999 through 2002 with ST-segment elevation or myocardial infarction or left bundle-branch block and receiving acute reperfusion therapy, Bradley et al assessed time from hospital arrival to acute reperfusion therapy. As previous studies have shown, nonwhites had longer times from hospital entry to reperfusion therapy, as much as 7.3 minutes longer for blacks receiving thrombolytic therapy and 18.9 minutes longer for blacks receiving percutaneous transluminal coronary angioplasty

Read the entire article here.

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